A subgroup of grossly obese patients may develop a large hanging abdominal apron, panniculus morbidus, which can contain an element of lymphoedema. This hinders normal activities and prevents adequate hygiene. We reviewed published reports and found that the complications that result from resection of a panniculus had been well described, but the presence of lymphoedema and the possible benefit of appropriate physiotherapy was not addressed. Our first aim was to assess our overall morbidity. Secondly we assessed whether perioperative complex decongestive physical therapy had the potential to reduce the incidence of commonly encountered complications. We retrospectively reviewed the casenotes of all massively obese patients who had panniculectomies between 1998 and 2008. We identified two groups of patients, in the first of which were 38 patients who were given perioperative complex decongestive physical therapy (CDP). In the second group were 18 patients who had no additional treatment perioperatively. We then compared the differences between the groups in the incidence of complications, reoperation rate, duration of hospital stay, and wound complications. All the patients not given perioperative treatment developed a postoperative complication. Only 6 patients in the treated group had minor wound problems. The rates and severity of complications associated with this type of operation can be improved if the patient has access to additional care in a specialised rehabilitation centre during the perioperative period.